Table 1.
Quantitative survey Uttar Pradesh sample sizes.
Table 2.
Qualitative method sample sizes.
Table 3.
Drivers of FP assessed in decision games.
Fig 1.
Little change in distribution of contraceptive use by method overtime in UP between 2006 and 2016.
Figure shows combined analysis of responses in quantitative surveys described in methods (NFHS and AHS) to the question: “Which method are you currently using to delay pregnancy?”, considering the highest/most used method. Lactational amenorrhea method (LAM) has been deducted from the “Any traditional method” indicator in AHS to match the corresponding NFHS definition for this indicator.
Fig 2.
Family planning awareness-intention-use cascade.
The figure shows descriptive analysis of 2016 DLFPS (n = 13,182 married women ages 15–49). Despite high awareness of modern methods (99% of women are aware of modern contraceptives and 94% are aware of modern temporary ones), there are large gaps between awareness, intention, and use. As shown, there is a 46% drop (bracket 1) between women who want to space/limit and women who to intend to use a modern method, a 55% drop (bracket 2) between wanting to space/limit and using any modern method, and a 78% drop (bracket 3) between wanting to space/limit and intending to use any modern temporary method. “Want to space” is defined as the response “not wanting to have child now/soon”. Any modern method includes female/male sterilization, IUCD, OCP, ECP, injectable, condom, standard days method, and LAM (note that % of standard days method and LAM are minimal). Any modern temporary method includes IUCD, ECP, OCP, and injectable. Only non-users were asked about intention to use methods in the DLFPS, hence, added current users to group because we assume that current users had intent.
Fig 3.
Figure shows a summary of qualitative journey mapping outputs (n = 6 women, 6 husbands, 6 mother-in-law (MIL), 6 ASHA, and 6 friends/family). The combined journey mapping analysis illustrates the different beliefs that either facilitate (+) or inhibit (-) progression to the next action tendency towards contraceptive use. Health beliefs are those about health risks to the mother and/or baby. Social beliefs include community norms and structural beliefs include anything related to family structure. At each action stage (awareness, intention, action, and consolidation) health, social, and structural beliefs determine whether a woman, husband, or mother-in-law (yellow and red lines) will seek more information, intend to use FP, use FP, and form FP habits. Influencers (circles) contribute to stakeholders’ beliefs at each stage.
Fig 4.
Analysis of qualitative findings suggest three potential pathways for FP. Interaction of social norms, risk perception, beliefs about side effects, shame, and other beliefs lead families to 1. Avoid FP altogether, or 2. Adopt a temporary method and eventually a permanent one or 3. Adopt a temporary method but additionally give on FP altogether. Additional quantitative research is needed to confirm pathways.